title: Evaluation of the pediatric Bonfils fiberscope for elective endotracheal intubation.
abstract: BACKGROUND
  Difficult airway management in children is a particular challenge for anesthesiologists and pediatricians. This study was designed to evaluate the performance of the recently developed pediatric versions of the Bonfils fiberscope for elective endotracheal intubation during routine surgical procedures.
  
  
  METHODS
  After approval by the institutional review board and written informed consent, 55 children (age 6 +/- 4 years) scheduled for elective minor surgical procedures were enrolled. Nineteen children received atropine before the intubation attempt, while in the remaining 36 children, no antisialogogue was used. For endotracheal tubes up to 3.5 mm internal diameter, a fiberscope with outer diameter (OD) 2 mm, and for larger endotracheal tubes, a fiberscope OD 3.5 mm was used. Time to intubation and failure rate were obtained.
  
  
  RESULTS
  In the 36 children without and the 19 children with atropine pretreatment, the success rate for tracheal intubation on the first attempt was 69%/78% (25/15 patients). 4/3 patients and 2/0 patients were intubated after two and three attempts, respectively, and in 5/1 patients (14%/5%) intubation failed even after three attempts. Time to intubation was median 58/60 s, 25th-75th percentile 35-100/32-110 s, and range 14-377/18-360 s. In both groups, failed intubations were because of the secretions contaminating the optic aperture.
  
  
  CONCLUSIONS
  High failure rate and increased intubation times suggest that the pediatric Bonfils fiberscope has significant drawbacks when used for intubation of normal pediatric airways.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. bein@anesthesie.uni-kiel.de
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.forename: Frank
authors.initials: F
authors.lastname: Wortmann
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Jens
authors.initials: J
authors.lastname: Scholz
authors.forename: Volker
authors.initials: V
authors.lastname: Dörges
mesh_terms: D002648:Child; D017558:Elective Surgical Procedures; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D013997:Time Factors; D017211:Treatment Failure